Provider Demographics
NPI:1275414971
Name:SMILE CREW ADAPTIVE & INCLUSIVE FITNESS LLC
Entity type:Organization
Organization Name:SMILE CREW ADAPTIVE & INCLUSIVE FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-5935
Mailing Address - Street 1:580 SAGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1848
Mailing Address - Country:US
Mailing Address - Phone:480-234-5935
Mailing Address - Fax:
Practice Address - Street 1:547 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2943
Practice Address - Country:US
Practice Address - Phone:480-234-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services